Bladder Cancer - Diagnosis

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How is bladder cancer diagnosed?

Bladder cancer is most frequently diagnosed by investigating the cause of bleeding in the urine that a patient has noticed. The following are investigations or tests that come in handy in such circumstances:

  • Urinalysis: A simple urine test that can confirm that there is bleeding in the urine and can also provide an idea about whether an infection is present or not. It is usually one of the first tests that is asked for by a physician. It does not confirm that a person has bladder cancer but can help the physician in short-listing the potential causes of bleeding.
  • Urine cytology: This test is performed on a urine sample that is centrifuged and the sediment is examined under the microscope by a pathologist. The idea is to detect malformed cancerous cells that may be shed into the urine by a cancer. A positive test is quite specific for cancer (for example, it provides a high degree of certainty that cancer is present in the urinary system). However, many early bladder cancers may be missed by this test so a negative or inconclusive test doesn't effectively rule out the presence of bladder cancer.
  • Ultrasound: An ultrasound examination of the bladder can detect bladder tumors. It can also detect the presence of swelling in the kidneys in case the bladder tumor is located at a spot where it can potentially block the flow of urine from the kidneys to the bladder. It can also detect other causes of bleeding, such as stones in the urinary system or prostate enlargement, which may be the cause of the symptoms or may coexist with a bladder tumor.
  • CT scan/MRI: A CT scan or MRI provides greater visual detail than can be afforded by an ultrasound exam and may detect smaller tumors in the kidneys or bladder than can be detected by an ultrasound. It can also detect other causes of bleeding more effectively than ultrasound, especially when intravenous contrast is used.
  • Cystoscopy and biopsy: This is probably the single most important investigation for bladder cancer. Since there is always a chance to miss bladder tumors on imaging investigations (ultrasound/CT/MRI) and urine cytology, it is recommended that all patients with bleeding in the urine, without an obvious cause, should have a cystoscopy performed by a urologist as a part of the initial evaluation. This entails the use of a thin tube-like optical instrument connected to a camera and a light source (cystoscope). It is passed through the urinary passage into the bladder and the inner surface of the bladder is visualized on a video monitor. Small or flat tumors that may not be visible on other investigations can be seen by this method, and a piece of this tissue can be taken as a biopsy for examination under the microscope. The presence and type of bladder cancer can be diagnosed most effectively by this method. In addition, fluorescence cystoscopy may be done at the same time; fluorescent dyes are placed in the bladder and are taken up by cancer cells. These cancer cells are visible (fluoresce) when a blue light is shined on them through the cystoscope and thus become visible, thereby making identification of cancer cells easier with this technique.
  • Newer biomarkers like NMP 22 and fluorescent in-situ hybridization (FISH) are currently in use to detect bladder cancer cells by a simple urine test. Some newer diagnostic tests are known as UroVysion, BTA, and the ImmunoCyt test. However, they have not yet achieved the level of accuracy to replace cystoscopy and cytology in the diagnosis and follow-up of bladder cancer.
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See what others are saying

Comment from: Shipwreck, 35-44 Female (Patient) Published: August 27

I was having severe anemia due to uterine fibroids and knew I was at hysterectomy stage. I went for an ultrasound and MRI for my fibroids and subsequent surgery. The ultrasound revealed a tumor on my bladder and the MRI did not. I followed up with a urologist and he thought it would be crazy for me to have a bladder tumor as I do not have any risk factors. He said the only thing was to do a cystoscopy and look to see if there truly was a tumor. I did have a tumor and had to have surgery to remove a low grade T1 extremely large tumor. I had no symptoms, no blood in the urine, only the ultrasound for other reasons discovered it. I have since had six rounds of BCG without incident. I have had two scopes since that have been clean. Every time I see my doctor he is amazed that I even have this problem as I am a healthy, active, athletic female who has never smoked. I am lucky that the ultrasound technician found the tumor on the ultrasound. I had the same ultrasound two years prior to monitor my fibroids with nothing on my bladder reported.

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Comment from: nanny, 45-54 Female (Patient) Published: January 20

Four days after being involved in a car accident I experienced sudden bleeding upon urination. I received treatment in the emergency room without good results. They tried to flush my bladder with saline. Several hours later I was released with a Foley bag and instructed to see my urologist the next day. Surgery was scheduled for the next day. A tumor was discovered and removed. My diagnosis was non-invasive papillary urothelial, carcinoma grade 3, and high grade. I did 6 weeks of BCG. Three years later I developed another tumor. Removal and another round of BCG. I've been clear for 1 1/2 years. My next checkup is in a month.

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